By Enyeribe Ejiogu
There is growing alarm among healthcare professionals around the world about the rising incidence of cervical cancer. Cervical cancer is one of the most common cancers seen in women worldwide.
It occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be successfully treated when it is found early. It is usually found at a very early stage through a Pap Test.
Cervical cancer is caused by human papilloma virus (HPV) infection. “Any female that has attained puberty (from 13 years to 19) can get HPV infection by having sexual contact with someone who has it, says Elochukwu Adibo, a biomedical research scientist and laboratory director of El-Lab Limited, which is a medical diagnostic and research centre in Festac Town, Lagos.
Adibo, whose area of special interest is histopathology, explains the connection between HPV and cervical cancer: “There are many types of HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms. Most adults have been infected with HPV at some time. An infection may go away on its own. But sometimes, it can cause genital warts or lead to cervical cancer.
What usually happens is that the HPV virus causes the release of toxins that affect the cells in the tissue of the cervix. Repeated exposure to HPV infection and increasing presence of the toxins cause change in the genetic material of the cells leading to mutation. Many years after the mutagenic cells begin to divide to form cancerous tissue around the cervix. That is why it is important for women to have regular Pap tests.
According to him, globally a woman dies every two minutes from cervical cancer. From analysis of data from two population cancer registries in Nigeria, Ibadan Cancer Registry (IBCR) and Abuja Cancer (ABCR), covering a two-year period, 2009–2010, the age standardized incidence rate for all invasive cancers from the IBCR was 66.4 per 100, 000 men and 130.6 per 100,000 women. In ABCR it was 58.3 per 100,000 for men and 138.6 per 100,000 for women. A total of 3393 cancer cases were reported by the IBCR. Of these cases, 34 per cent (1155) were seen among males and 66 per cent (2238) in females. In Abuja over the same period, 1128 invasive cancers were reported. 33.6 per cent (389) of these cases were in males and 66.4 per cent (768) in females. The study showed that breast and cervical cancer were the commonest cancers among women and prostate cancer the most common among men.
With HPV infection clearly established to predispose women to developing cervical cancer in the near future, the World Health Organisation working with other health sector bodies determined from medical research that teenage girls that have not yet become sexually active and therefore not exposed to HPV infection could be protected from the virus if the vaccine is administered to them.
Hear Adibo, who practiced in Britain before returning to the country and still maintains close contact with professional colleagues in Europe, some of who he mentors through Skype: “What happens overseas is that they use the information stored in the database about every woman that comes into the clinic, to identify women who need to undergo certain tests. Every age group among females is registered under the National Health System of Britain. So they identify those that have had the cancer shot, what we call HPV (human papilloma virus) vaccine. They also find out women that need to have the Pap Test. They are informed and invited through email or text message to come in for the test. They vaccinate both male and female, once the person has reached 13. Even 12-year-olds are being vaccinated. The person would go to the nearest NHS centre to do the necessary test or get the shot. But in Nigeria the system is not organized to deliver this service. That is why all Nigerian health practitioners both in public service and private practice must take a sense responsibility to begin to organize our healthcare system.
“On our part, we established a collaboration with Maternal and Child Health Centre, a Lagos State government facility in Amuwo Odofin, which is close to us. We have an agreement with the management of the hospital, whereby we go there to give information about cervical cancer and educate women and mothers who come for maternal or child healthcare.
For us, the banner we put up at the centre and in our own reception has helped a bit and made people who visited our facility to ask questions about cervical cancer. Such people wanted to know more about the way forward and how to access the service.
“Some make the inquiries and follow up, but some never follow it up. The reason they do not follow up is that there they feel no pain in the body, everybody feels it is something they can do at their own time. But individuals who have heard news about family members or anyone suffering from this dreaded disease are the ones that do the response very quickly. You find that some days, you see women rushing in, saying they want to Pap Test. In this year alone, we have had about 151 come to do Pap Test, which is a standard international test to know if a woman has been exposed to any stage of cervical cancer. A lot of laboratories do not even bother to keep records. Because of our consciousness for research, we keep accurate records of the tests we conduct at El-Lab and make the data available to relevant international bodies focused on cervical cancer research. The figure is just a tip of the over 15000 people that access tests in our facility in one year.
“Other practitioners can take the same steps we have taken, to establish a relationship with a government facility where most women of child bearing age access maternal healthcare, and if that kind of collaboration is replicated around the country, then we can make some progress towards reducing the incidence of cervical cancer as more and more women go to have Pap Test.”
In line with this, Adibo says, “if all the gynaecologists in the country who operate private clinics have a practice of advising women who have had babies in their facilities on the importance of doing the Pap Test and then encouraging them to actually undergo the check, this will greatly help to reduce the incidence of cervical cancer, which will definitely rise rapidly in the near future.
“Then, we have the issue of vaccination against HPV. There are a number of companies in the country who have the requisite vaccines, but they need coordination to offer this vaccination under a well-organised national programme. All professional bodies in healthcare and other relevant bodies must be involved in putting out the word about cervical cancer and the looming increase in the incidence of the disease. We must all come together and stop it before the epidemic happens. Prevention is always much, much better and less costly for the government, than curing the disease.
“There is great need to create the legal framework and modalities for carrying out vaccination of teenage girls in schools under a national programme that will be funded by the government, foreign donor agencies and the Nigerian private sector as part of their corporate social investment initiatives. That is why the Federal Ministry of Health and the Federal Ministry of Education should work together to create the framework and modalities. And also get the National Assembly to turn the framework or modalities into a legislation that would have the force of law. This will create a will and support for the programme as it would allow the private sector and the relevant civil society groups that can sponsor vaccination campaigns in schools to do so.
“Then there has to be massive public education long before getting to the stage of actual administration of the vaccine on teenage girls, particularly those between the age of 12 to 14 years, when they have not yet been exposed to sex for the first time and therefore not yet infected with HPV. This will prevent what is yet to come. Even for those that are older (15-19 years), vaccination can still tame the HPV infection. Honestly this will make all the difference.
In advanced countries they are gathering statistics on the incidence of HPV infection and cervical cancer, and what they are seeing is very alarming. Both the Executive and the Legislature must wake up to the reality that the incidence of cervical cancer will increase rapidly.
“Our women are our sisters, wives, mothers and grandmothers. If we truly love them, then we the men must rise to the occasion and create a massive awareness about this scourge. Therefore all Nigerian parents need to know the urgency of giving their daughters opportunity to get vaccinated against HPV, which will protect them from developing cervical cancer.”